Individual
MR. CONNOR R CIMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6 EAGLE CTR STE 1, O FALLON, IL 62269-1945
(618) 206-8816
Mailing address
404 S CARBON ST, MARION, IL 62959-1318
(270) 564-5354
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
317957959
—
IL
Enumeration date
02/10/2021
Last updated
02/10/2021
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